30/11/2025
ApoB vs LDL-C — Should ApoB Replace LDL-C?
Arguments For and Against
1. ApoB is a Better Marker of Atherogenic Risk Than LDL-C
Most observational analyses — primary and secondary prevention — show ApoB tracks cardiovascular risk more precisely than LDL-C.
Why?
👉 Each atherogenic particle (LDL, VLDL remnants, IDL, Lp(a)) carries one ApoB → reflects particle number, not just cholesterol content.
2. LDL-C and ApoB May Be Concordant in Populations but NOT in Individuals
Significant discordance occurs even in people without high TG or metabolic syndrome.
Meaning:
👉 Relying only on LDL-C misses many patients with high particle numbers but “normal” LDL-C.
👉 Such patients carry hidden residual risk.
3. ApoB is More Stable, More Accurate, and Fasting-Independent
ApoB is:
Not affected by fasting
Not distorted by elevated TGs
More reliable at very high or very low LDL-C levels
Clinical trial data show that goal values align numerically:
👉 If LDL-C goal =
